Can one word influence a patient’s treatment decision?
TORONTO, Ontario, March 21, 2019 – When we think of the word ‘cancer,’ we associate it with an aggressive and lethal disease. However, innovations in screening and diagnostic tests can detect ‘cancers’ that – even if left untreated – pose very low-risk of growth or progression to later stages and near-zero risk of mortality. Still, many of these low-risk cancers are treated aggressively and those treatments can have serious side effects. Recent research from Drs. David Urbach and Peter Dixon at Women’s College Hospital (WCH) investigated the role that the word ‘cancer’ plays in the treatment decisions that patients make and whether the language used to label a condition can lead to overtreatment within the healthcare system.
The study, published today in JAMA Oncology, surveyed over 1,000 adults and analyzed the decisions they made for different hypothetical scenarios of low-risk thyroid cancer. The disease label varied in different scenarios, allowing the scientists to understand how influential disease label is relative to other attributes that accompany a cancer diagnosis, including its recommended treatment and prognosis.
“Thyroid cancer is one example of a condition which, in some cases, might never cause a patient any problems if left untreated and simply monitored. Our ability to identify which cases are very low-risk is improving, but some patients still prefer aggressive treatment,” says Dr. Dixon, lead author and surgical resident, WCH. “We expected that the word ‘cancer’ could trigger an emotional response and lead to misunderstanding about prognosis, but we were surprised at how much that word alone could influence decisions.”
Drs. Urbach and Dixon found that participants were willing to accept a worse prognosis in order to have a condition that was otherwise identical but wasn’t called ‘cancer.’ The disease label was just as important to participants as whether or not they had to undergo surgery, which was associated with significant potential risks including temporary or permanent hoarse voice, daily thyroid replacement pill for life, neck scar, and life-threatening bleeding after surgery. When the disease label was ‘cancer,’ participants were three times more likely to choose surgery than under any other disease label, even when participants were told that surgery would result in a higher risk of the cancer growing or coming back. These findings suggest that surgically removing the disease is a strong instinct when we label the disease as ‘cancer,’ contributing to overtreatment of low-risk malignant tumours within the healthcare system.
“It was clear from our findings that preexisting perceptions about cancer from personal or others’ experiences amplify patients’ responses to diagnosis and play a significant role in treatment preferences,” adds Dr. Urbach, senior author, surgeon-in-chief, WCH and senior scientist, Women’s College Research Institute. “It’s important that we use this information to educate healthcare professionals on how to improve communication with their patients about the treatment risks, benefits and disease history to ensure they are making informed choices.”
Women’s College Hospital
For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in the health of women and Canada’s leading, academic ambulatory hospital. A champion of health equity, WCH advocates for the health of all women from diverse cultures and backgrounds and ensures their needs are reflected in the care they receive. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system as a whole.
Women’s College Research Institute (WCRI) is tackling some of the greatest health challenges of our time. Its scientists are conducting global research that advances the health of women and improves healthcare options for all, and are then translating those discoveries to provide much-needed improvements in healthcare worldwide.